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The impact of systemic immunomodulatory therapy on the intraocular inflammation and the need for topical glucocorticoid therapy in patients with juvenile idiopathic arthritis-associated uveitis

Juvenile idiopathic arthritis associated uveitis (JIA-U) is the most common and potentially most destructive extraarticular manifestation of JIA. The aim of this research was to determine the need for topical glucocorticoid therapy (TGC) in patients with JIA-U on systemic biological therapy in comparison to patients treated with methotrexate (MTX) only. We have conducted longitudinal observational study with JIA-U patients in whom systemic immunomodulatory treatment (IMT: biologics and/or MTX) was introduced and who were followed at least 3 months in the period between 2011 and 2017. The data about the number of cells in the anterior chamber (AC) according to Standardization of Uveitis Nomenclature (SUN) Working Group criteria, about TGC and systemic therapy and JIA complications were collected on each examination. Generalized linear mixed models were used to analyze the relationships between treatment with biologics, MTX, TGC and the grade of inflammation in AC according to SUN criteria. 38 JIA-U patients (69 eyes) with median (range) age of 4.9 (2-15) years and follow up period of 209 (19-381) weeks were included. There were a total of 1205 examinations. At the first examination JIA-U was detected in 16 (42.1%) of patients, 59 (79.7%) of the eyes had ≤1+ cells in the AC, and in 19 (50%) of JIA-U patients complications were already present. MTX was introduced in 23 (60.5%) JIA-U patients before the inclusion in the study, 8 (21%) has already received biologics, while in 4 (10.5%) prior systemic glucocorticoids were also used. Until the end of the study, all patients received MTX and 40% JIA-U were treated with biologics. The average number of TGC doses decreased from 3.74 at baseline to 0.72 in the 48th month. After Friedman and the post hoc test a significant difference in the daily doses of TGC could be seen from the 12th month after application of systemic IMT. The number of daily doses of TGC as well as the degree of inflammation in AC per eye decreased over time. Using generalized linear mixed models it was shown that the treatment with biologics, but not with MTX and systemic glucocorticoids, was associated with lower intensity of TGC therapy. Treatment with biologics and systemic glucocorticoids, but not with MTX, were associated with lower degree of inflammation in AC. The results showed that the application of systemic biological therapy may result in less intensive TGC therapy, resulting in glucocorticoid-sparing potential, and reducing intraocular inflammation.

JIA ; uveitis ; immunomodulatory treatment

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